Department of Public Health, School of Medicine, University of Naples "Federico II", Naples, Italy.
Obstetrics and Gynecology Unit, "Villa Sofia Cervello" Hospital, University of Palermo, Palermo, Italy.
Biomed Res Int. 2017;2017:2518396. doi: 10.1155/2017/2518396. Epub 2017 Aug 9.
Uterine adenomyosis is a common gynecologic disorder in women of reproductive age, characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and deep dyspareunia are common symptoms of this pathological condition. However, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies. The recent evolution of diagnostic imaging techniques, such as transvaginal sonography, hysterosalpingography, and magnetic resonance imaging, has contributed to improving accuracy in the identification of this pathology. Hysteroscopy offers the advantage of direct visualization of the uterine cavity while giving the option of collecting histological biopsy samples under visual control. Hysteroscopy is not a first-line treatment approach for adenomyosis and it represents a viable option only in selected cases of focal or diffuse "superficial" forms. During office hysteroscopy, it is possible to enucleate superficial focal adenomyomas or to evacuate cystic haemorrhagic lesions of less than 1.5 cm in diameter. Instead, resectoscopic treatment is indicated in cases of superficial adenomyotic nodules > 1.5 cm in size and for diffuse superficial adenomyosis. Finally, endometrial ablation may be performed with the additional removal of the underlying myometrium.
子宫腺肌病是一种常见的妇科疾病，好发于育龄期妇女，其特征是子宫内膜腺体和间质异位至子宫肌层。痛经、异常子宫出血、慢性盆腔痛和深部性交痛是这种病理状况的常见症状。然而，腺肌病在子宫切除术或子宫活检标本中通常是偶然发现的。最近诊断影像学技术的发展，如经阴道超声、子宫输卵管造影和磁共振成像，有助于提高对这种病理的识别准确性。宫腔镜检查具有直接观察子宫腔的优势，并可在直视下采集组织学活检样本。宫腔镜检查不是治疗腺肌病的一线方法，仅在局灶性或弥漫性“表浅”型的少数情况下可行。在门诊宫腔镜检查中，可以切除表浅的局灶性腺肌瘤或清除直径小于 1.5cm 的囊性出血性病变。而对于直径大于 1.5cm 的表浅腺肌瘤性结节和弥漫性表浅腺肌病，则需要进行电切术治疗。最后，子宫内膜消融术可联合切除下方的子宫肌层。
